Hon STEVE CHADWICK (Associate Minister of Health) on behalf of the Minister of Health: I move, That the Public Health Bill be now read a first time. At the appropriate time I intend to move that the bill be referred to the Health Committee for consideration and that the committee present its final report on or before 24 June 2008. The proposed Public Health Bill will update New Zealand’s currently fragmented and very outdated legislation for public health and become the primary health statute. It will replace the Health Act of 1956 and the Tuberculosis Act of 1948. In fact that Act will be almost 60 years old at the passing of this bill. This bill is designed to improve, promote, and protect public health—truly a primary health measure. It sets out specific responsibilities for the identification and management of risks to public health, in particular those arising from communicable diseases—diseases that can be spread from person to person, such as tuberculosis, HIV and AIDS, and non-communicable diseases, such as diabetes and cancer, and also protections to the environment.

A particular new feature of the bill is that it provides for an all-risks approach—that is, an approach that allows for comprehensive management of all significant and emergent threats to public health. The Public Health Bill is an extensive piece of legislation, covering many facets of health. The bill will continue the traditional public health focus that we all know on communicable disease control and on environmental health issues, such as water quality, food safety, and drinking-water monitoring.

The bill will also expand on health emergency provisions in the Health Act, which currently deal only with epidemics of communicable diseases, to all actual, or even potential, public health emergencies, irrespective of the cause. We have all realised the need for an all-of-Government response to potential pandemics, and this bill takes account of changes in international travel patterns and threats, such as SARS and pandemic influenza, to enable the range of risks to public health to be managed at New Zealand’s own borders. New Zealand can be congratulated on its planning approach. The bill includes new provisions aimed at reducing risks of non-communicable diseases, which include the power to issue guidelines and to make regulations. There are several reasons why this new public health legislation is required.

Public health legislation has traditionally focused on controlling infectious disease and on ensuring a safe environment—for example, by preventing overcrowding in houses or providing for sewerage systems. The bill continues that focus, because it is important, but modernises and updates approaches and terminology to reflect the 21st century. In particular, the bill reflects that human rights and the notion of individual freedoms have advanced significantly since the Health Act was enacted some 60 years ago. The bill ensures that public health powers are exercised within a human rights framework. This means that individuals are informed about the applicable law, time frames are given, and the right to appeal is explicit. The bill balances the rights of the individual against those of the public interest to be protected from diseases or other threats to public health—a very important aspect. Where individual rights are limited in the public interest, the bill ensures that safeguards are provided—also a very important aspect.

The current Health Act tends to provide an all-or-nothing approach for managing risk. For example, in relation to communicable disease, the only power currently available is to detain a person with a communicable disease, which is a very old-fashioned approach. In contrast, the bill provides that public health risks are managed with responses that are commensurate in proportion to the risk. Throughout the bill, tiered options, or pick-and-mix menus, are provided depending on the disease confronted, and that is very important. Further action must be proportionate to the risk. The bill provides that the least restrictive option and alternative must be applied when managing health risk.

Another reason we need this new public health legislation is that our current legislation focuses on issues that were only current 50 years ago. Fifty years ago our public health issues were communicable diseases, such as tuberculosis and typhoid, and environmental health. Issues such as a lack of sewerage and non-sanitary buildings are a picture of long ago. Although communicable disease and environmental health are still important issues, we now face other threats to public health. For example, when the Health Act was drafted ships were the predominant mode of international travel. Now most people fly between countries, making the spread of conditions that are a very serious risk to public health so much easier. These changes in international patterns, and new threats such as SARS and the pandemic influenza mean that we need to be able to manage all kinds of risks at our borders. The bill updates and clarifies provisions to protect our borders, and expands the current emergency provisions that deal only with disease epidemics.

Heart disease and cancer are now the two leading causes of death in New Zealand, as well as being significant drivers of health expenditure. In order to reflect the significant impact that non-communicable conditions have on death and ill health in New Zealand, the bill has new provisions for dealing with non-communicable disease risk factors. Health has never been about hospitals and surgical volumes alone. The bill provides for the Director-General of Health to issue non-binding codes of practice or guidelines about non-communicable disease risk factors. It also provides the option of making regulations to reduce, or to assist in reducing, risk factors associated with communicable diseases.

As indicated, the Public Health Bill covers a wide range of public health issues, and is one of the foundation pieces of legislation that supports a modern health system. The Health Act has served us well for 50 years, but it is time that it is replaced with modern legislation. The Public Health Bill will enable New Zealand to be more effectively protected from all risks to public health. I am very aware of the high level of interest from public health officers, medical officers of health, and practitioners, in the introduction of this bill tonight. I commend the Public Health Bill to the House.

Hon TONY RYALL (National—Bay of Plenty) : The public will be wondering why Parliament is sitting under urgency to introduce legislation that talks about protecting our country from cholera, yellow fever, and the plague. I am reliably informed that the arrival of these diseases to our shores is not imminent, but new public health issues are asserting themselves in this new century. Severe acute respiratory syndrome, bird flu, obesity, and diabetes present actual or potential challenges to New Zealand’s public health. The updating of the Public Health Act is overdue, and much of this bill represents improvement on the 1956 legislation.

The bill moves beyond dealing with the prevention, monitoring, and control of communicable diseases such as TB and cholera. For the first time, it is proposed that public health laws will include measures to deal with non-communicable diseases like obesity and diabetes. This is a significant step, underplayed by the Minister. The National Party has considerable concerns about this proposal. In particular, we question the so-called voluntary codes, and the sweeping powers to regulate just about everything we do, that are hidden in clause 374. Parts of this bill smack of nanny State gone too far. Communities and individuals want to be empowered to make choices to achieve their goals. New Zealanders do not want to be told what to do by some central agency, and given no support other than to follow orders.

New Zealanders are fed up with this Labour Government interfering in their lives, and parts of this bill will hand control of many of our choices to the Wellington bureaucracy. Let me explain National’s concerns. The first is the issue of voluntary codes—the so-called voluntary codes. Clause 81(1) grants the Government the power to issue a code of practice or guidelines to a sector of a particular activity that the sector undertakes, where the Government believes “that the sector can reduce, or assist in reducing, a risk factor associated with, or related to, an activity. Clause 83 spells out what a code can provide. It includes, under subclause (2)(d), “the accessibility of specified goods, substances, or services to members of the public or to sections of the public, in particular, to minors:”; and under subclause(2)(e), “the ways in which specified goods, substances, or services are advertised, sponsored, or marketed (whether directly or indirectly):”. The Government also wants codes for the provision, under subclause (2)(f), of “the information to be given to consumers of specified goods, substances, or services, whether as part of any advertising, sponsorship, or marketing or as part of any packaging or labelling of goods or substances.”

These are wide-reaching provisions. Although the ministry must consult with industry representatives prior to issuing a code, the final decision will rest with the ministry. Further, the Ministry of Health will have to report in 3 years on the effectiveness of these so-called voluntary codes, and no doubt that will lead to enforceable codes. Our question to the Government asks: if these codes are voluntary and not legally enforceable, why are they included in the law? If these codes are to be voluntary and are not to be legally enforceable, why are they included in the bill? If this Government truly had no secret agenda, then voluntary codes would be just that—voluntary, and agreed cooperatively. Instead, we have a Trojan Horse where voluntary codes can, on the signature of a Minister, become compulsory.

Secondly, our concerns focus on clause 374, and on paragraph (x) in particular. This clause completely undermines the Government’s argument that there are no coercive powers for its food police. This clause allows untold regulation in the name of dealing with non-communicable diseases such as obesity and diabetes. Clause 374(x) states that the Government may regulate in any way for the purpose of “reducing, or assisting in reducing, risk factors … associated with, or related to, non-communicable diseases:”. A “risk factor” is further defined in clause 79 as “a thing or substance that, on its own or together with other things or substances or conditions, may, … give rise to, or increase the incidence of, non-communicable diseases … in the general population or in communities …”. Put together, that means that the Government has an unfettered ability to reduce any risk factors associated with any non-communicable disease. It has carte blanche to deal with that. This clause gives the Government breathtaking powers to regulate what we eat, what we see, and what we choose. For example, this clause will allow the Government to regulate what appears where on supermarket shelves. This clause will allow the Government to restrict the sale of fish and chips to adults only or to children accompanied by adults. This clause will allow rules being enforced in school tuck shops to be enforced in workplaces and homes throughout the country.

Bob Clarkson: You’d better hurry; this is under urgency.

Hon TONY RYALL: It is being done under urgency, but what is worse is that this provision, this sweeping regulatory provision, warranted fewer than seven or eight words in the Minister’s introductory speech. We also draw the House’s attention to clause 374(r), which allows the Government to halt at the border any products that it sees contributing to non-communicable diseases. Surely a Government must be able to achieve its goals for public health without telling its people how to live their lives or feed their families.

The Government tells us that industry is working very cooperatively with it. The Government claims great progress. If that is true, then these provisions are at best unnecessary or at worst Draconian. There is no doubt that obesity and diabetes are major challenges for our people and our health system. As National states in its health discussion document, encouraging individuals and members of at-risk communities to adopt healthier lifestyles can make a big difference. Besides increasing awareness about health issues, promotion should identify and target the sociocultural aspects of human behaviour. Our cultural hard drive has to alter so that healthy choices are preferred. A successful long-term approach will provide people with the education, skills, and desire to make healthy dietary and lifestyle choices, and stick to them.

People make personal decisions every day that affect their health and well-being—exercising, drinking, smoking, and eating. Although these choices may be shaped by public health messages and cultural experience, they are still choices that individuals are responsible for. The Government should be providing the information and support that people need to make healthy choices, instead of making those choices for them. Surely we must have a country that can achieve its goals for public health without telling its people how they have to live their lives.

National will support the passage of this bill to a select committee, but we make it very clear to the Government and the Ministry of Health that we are not prepared to countenance the unfettered regulatory power that this bill proposes to give central government.

Hon MITA RIRINUI (Associate Minister of Health) : I rise to support the Public Health Bill. The Public Health Bill is fundamental health legislation. It is extensive and it covers many areas of public health. The bill is designed to improve, promote, and protect public health. It includes provisions designed to manage actual and potential risks to public health, to give clear responsibilities and accountabilities, to ensure monitoring and reporting of public health risks, to give explicit emergency powers, and to avoid undue infringement of human rights and privacy.

A main feature of the bill is that it sets out the purpose, powers, functions, and duties of the various key players, including the Minister of Health, the Director-General of Health, the Director of Public Health, the district health boards, and the territorial authorities and statutory officers—namely, medical officers of health, health protection officers, and environmental health officers. The bill organises the key players into three levels of operation: locally, through statutory officers; regionally, through district health boards and territorial authorities; and nationally, through the Minister of Health, the Director-General of Health, and the Director of Public Health.

The bill contains provisions regarding health information, notification, and cervical screening. The health information provisions largely reproduce the Health Act, which defines and provides the routine information flows of personal health information, updates existing audit provisions, and provides for notification of specified conditions. Notification provisions include, for example, a duty on medical practitioners in laboratories to report conditions such as typhoid.

As will be mentioned in further detail in other speeches, the bill contains provisions relating to non-communicable disease risk factors. These provisions provide principles and non-binding codes for reducing non-communicable disease risk factors—for example, through improved nutrition—as well as legislate for a parliamentary report back on possible further legislative measures to address non-communicable disease risk factors. The bill also provides the option of making regulations to reduce, or assist in reducing, risk factors associated with non-communicable diseases.

The bill contains provisions to manage conditions posing a health risk. Communicable conditions such as HIV, hepatitis, and tuberculosis pose risks of infection to others unless appropriate steps are taken to prevent or minimise such risks. The current Health Act simply provides for the detection of people with notifiable conditions through the decision of the medical officer of health, with no time periods or appeal provisions specified other than that the person may be held until he or she is no longer infectious. In contrast, this bill aims to build on existing provisions in the Health Act and the Tuberculosis Act, within a human rights framework that includes explicit time periods and appeal provisions.

The bill also aims to provide a range of options—rather than only the detention option in the Health Act—for preventing the spread of communicable conditions that pose a risk to public health. Contact tracing involves identifying and seeking people who have been in contact with a person who has a communicable disease, such as tuberculosis, in order to prevent the further spread of the disease. The bill includes provisions that enable medical officers and medical health practitioners to undertake such contact tracing.

Local government already has an extensive public health role under the Health Act, principally in relation to environmental health—in other words, public health matters related to the physical environment, such as sewerage. The bill largely reproduces the Health Act functions of territorial authorities in relation to environmental health, with minor modifications to update and modernise the language. The bill introduces a new framework to regulate activities that may pose a public health risk. Industries that are regulated under public health provisions, such as camping grounds and hairdressers, will continue to be regulated in the same way as they are now. At some point in the future, and with consultation, the regulations will be revised to reflect the new framework, and consideration may be given in the future to whether other activities that pose a risk to public health should be regulated under the framework.

The bill implements an all-risks approach to emergencies by providing special powers that can be used to manage an actual or imminent public health emergency, irrespective of cause. This means infectious diseases, as well as emergencies arising from physical, chemical, or radiological factors. The border health protection provisions aim to prevent, reduce, or eliminate the spread of risk to public health at the border. They relate in particular to people and craft coming into or leaving New Zealand, as possible sources of infection. I commend this bill to the House.

JO GOODHEW (National—Aoraki) : I rise to speak on the Public Health Bill 2007 along with my colleagues. We will be supporting this bill going to the select committee, but as has been outlined by the Hon Tony Ryall it is with some misgivings. We have considered this bill and have looked into the bill and have many, many questions. The first of those questions must be why this bill is being considered under urgency. What exactly, after 50 years, requires it to be considered this year rather than next February? However, putting that aside, we will be supporting the bill as it passes, as we expect it will.

This bill will head in two directions in particular. The first direction is reviewing the current legislation—the public health legislation—and we know that it is woefully outdated. The second direction is looking at the promotion of public health, and that is where we get into, shall we call it, uncharted territory. That latter direction gives me and my colleagues some cause for concern. It is a little bit like the question, how long is a piece of string? We are very unclear, in reading this bill and in looking at it, just exactly what some of the provisions will encompass and what they will mean in the long run. I think that my colleague the Hon Tony Ryall hit the nail on the head when he said that when we take codes and, with the stroke of the Minister’s pen, put them into legislation, then we are providing a very powerful, powerful thing for the Minister to do. When we are talking about non-communicable diseases, then I can tell members that we have some cause for concern.

The purpose is all-encompassing and there is no doubt that when it comes to some aspects of that woeful, and now inadequate, 1956 Health Act, there needs to be an all-encompassing update of the legislation. But there are examples of the sorts of things that one would expect in a public health bill, such as the declaration of a health emergency, the assessment of the risks to public health, and the appointments of health protection officers or the medical officer of health that one might expect would be in the bill. Health information is one aspect that is covered in the newer parts of the bill. The access that health professionals will have to information is, I think, very topical right now, and it will be very interesting to get a very good picture within the select committee of how New Zealanders see that part of the bill working.

Of concern to us are the non-communicable disease provisions within the bill, which relate to diseases such as cancer, cardiovascular disease, and diabetes. There are some very broad and woolly statements in the bill. I will just explain to members what I mean by that and give the examples of these quite broad and woolly statements. The Director-General of Health, in exercising his or her functions, must take into account the importance of improving and enhancing the health of communities by addressing broad determinants of health, including risks factors. That is a very wide set of considerations. He or she must manage or eliminate risk factors by involving communities, sectors, and Government agencies. That is all of us. He or she must consider the well-being and mutual interdependence of families and their communities, including whānau, hapū, and iwi, promoting, maintaining, and enhancing the health status of the general population and communities. That is a pretty broad statement again. Lastly, he or she must also implement public health objectives through coordinated action. There is not much that cannot be covered by this bill, in other words.

It is here that we come to the codes of practice and guidelines, and, as has been outlined by the Hon Tony Ryall, the bill authorises the Director-General to issue those codes of practice or guidelines to a sector on a particular activity. That is all about, as has been outlined by the Hon Steve Chadwick, an all-risks approach. We have already seen an all-risks approach in the Health Committee quite recently. It was in relation to drinking water.

The last thing I will outline in my discussion on this bill tonight is in relation to the territorial local authorities and their particular responsibilities under this bill, because I have some concerns. The bill sets out the general powers and duties of territorial local authorities in respect of public health, and they already have some responsibilities in this area. It talks about the necessity for them to control nuisances. I was quite perplexed by the word “nuisance” and I wondered what this meant. Clause 166(2) states: “A nuisance may, without limitation, arise from or be constituted by any 1 or more of the following:”—and I was not concerned about these—“(a) buildings or structures: (b) land, air, water, or land covered by water: (c) animals, insects, or birds: (d) refuse or accumulations of material: (e) noise or vibrations: (f) emissions or discharge.” But then it got a bit trickier. Clause 166(3) states: “In particular, a nuisance may arise from or be constituted by any 1 or more of the following:” Now, there are paragraphs (a) through to (f) here, but I will not take the time over them all. I just want to tell members that amongst them are “(d) dirt or odour: (e) animal carcasses: (f) composting.”—they constitute nuisances. Under this bill a territorial local authority is required to regularly patrol or go looking for those particular nuisances. I just wonder whether they will be coming past my section, looking to see whether I am doing any composting, or whether there is any dirt or odour. I wonder whether they will notice, as I did, that there is a dead hedgehog down the back of my section that smells somewhat at the moment.

It may seem like I am being overly light about this particular bill, but I am saying that the select committee members will need to be very careful when we examine the bill, when we call for submissions, and when we hear those submissions, that we hear whether this bill goes too far. I believe there is a possibility that it will be too encompassing—that it will give too many powers to the Director-General and, by the stroke of a pen, to the Minister. Therefore the National members of the select committee will be very diligently listening to the people of New Zealand as they submit on this particular bill.

BARBARA STEWART (NZ First) : On behalf of New Zealand First I rise to support the Public Health Bill going to a select committee. I must admit that when I heard one of the previous speeches I actually wondered whether I had a copy of the same bill as that particular speaker. I have checked, and I definitely have the same bill, but my interpretation is quite different in many ways from that of the member. So I can see we will have a very interesting debate at the select committee.

This bill is not part of a conspiracy; it more than likely should have been completed a long time ago. It was not just deliberately put through under urgency in any conspiracy mode. I believe that the first reading is being completed at this particular time so that the select committee can get to work on the bill as soon as possible, after the adjournment. It is timely to update this legislation; it has not been done for some time. It is long overdue.

As other speakers have said, this legislation will replace the Health Act of 1956 and the Tuberculosis Act of 1948. By my calculations the Health Act is over 50 years old, and many aspects of life have actually changed quite markedly since its introduction. The Act now does not reflect contemporary public health issues or contemporary human rights and values.

This is important legislation, and the public of New Zealand and those people involved in the health area will be very keen to have some input into this bill. It is a pretty hefty piece of legislation—there are many, many pages there—and it covers aspects of health from the roles and responsibilities of various officials in the health system through to health information. It also covers reporting in cervical screening—and I must say that was an area I thought was rather settled now—management of conditions posing health risks, through to emergencies and border health. There is a high level of accountability within this particular bill. I was very interested to read that territorial authorities have an extensive role—principally in relation to environmental health, under which, of course, comes food and drinking water. The bill is an extensive update and, hopefully, it will have a similar life to that of the previous legislation. So it needs to be right. We need to make sure during the select committee process that we have everything absolutely right.

This legislation is important because it will become New Zealand’s primary public health statute. Fifty years ago, immunisation for many diseases did not exist. Some diseases that are relatively common today were previously unknown—and here we can talk about cancer and heart disease. The 1956 Act was relatively silent on non-communicable diseases. We all know that one of those diseases is obesity, and closely related to that is diabetes. Communicable disease control includes the controls necessary for HIV and AIDS, which were diseases that were not even identified in the original legislation. Today we have to take account of changes in international travel and of threats such as severe acute respiratory syndrome and bird flu, which are best identified at the border rather than having some sort of reactive response in New Zealand.

We also have to be concerned about some of the diseases that some immigrants are bringing into this country, and here we are particularly referring to tuberculosis. We have to be aware that the strain of TB that is now prevalent in New Zealand today is resistant to today’s drugs and can be only managed rather than cured, and that in itself is quite a concern to us. I think it would be fair to say that most New Zealanders believed that New Zealand was on top of all Third World diseases, but, unfortunately, the reality is that we are not. It is a fact that all of the guilty parties that are right here in this Parliament, and that have directed comments about xenophobia in New Zealand First, have, at the same time, opened the public purse to cure the Third World diseases that have been brought in—and I can see some heads nodding in agreement. We are told that there is a large number of TB cases in Auckland hospitals; in fact, some wards are dedicated entirely to TB, a disease that most New Zealanders believed had been totally eliminated here in New Zealand. So risks to public health do need to be managed, and managed very carefully. In New Zealand First we believe in the precautionary principle and we think it is of paramount importance.

I was very interested to read in the explanatory note of the bill that the risk management approach will be paramount in this bill, and, of course, we could see that in the epidemic preparedness legislation that we passed earlier in the year. The bill notes that this approach is going to operate locally through the district health boards and nationally through the Minister and other high-level ministerial roles. However, the last thing that most New Zealanders would want to see—and I know National members would agree with me, in this particular instance—is the construction of 21 different plans in 21 different locations. We accept that there can be some regional variations, but not to any great extent.

In New Zealand First we were quite interested, too, in the contact-tracing requirements. It is absolutely essential to have these provisions in place in order to identify and seek people who have been in contact with a person with a notifiable condition, to prevent the further spread of that condition, and, of course, to offer treatment. We had that situation earlier in the year in respect of the Zimbabwean refugees and AIDS. We actually believed that this would have been the current practice, but if it has not been legislated for, then it has to be.

We were very interested to read in the bill that the following activities are regulated by the Health Act, and that they will continue to be regulated under their current regulations in the bill. It is a pretty diverse list, from camp grounds, to hairdressing, to burials and funeral directors, to needle and syringe exchange programmes, to the manufacture, import, and assembly of microwave ovens, and to the business use of plastic wrapping. We understand that after this bill is enacted, these regulations will be reviewed under the new framework that is being provided in the bill. We also understand that no additional activities are included in the bill, but any that might be in the future—for example, tattooing—will be included only after a consultation practice. We would also have liked to see sun beds and sunscreen included in the consultation process.

In conclusion, I say this is a very interesting bill with many different parts that will no doubt be very carefully examined by all of the members on the select committee. I must say we all expect the Government to be adequately prepared for any public health crisis, and this is an attempt to update this particular legislation and to be prepared. New Zealand First supports this legislation, and we look forward to receiving submissions from all of those parties that are going to be affected by this bill.

SUE KEDGLEY (Green) : It seems that there will be a consensus of support right across the House on this Public Health Bill. The Greens are delighted that this is so, even though it is an incredibly complex bill of 259 pages dealing with all sorts of minutiae, as the previous speaker said, from hairdressers and shops to microwave ovens, operating camping grounds, mortuaries, and many other details. Nevertheless, it is an important bill and we are particularly pleased that this bill, as it says in its explanatory note, is addressing non-communicable diseases and environmental health issues—public health issues. It points out that the major causes of population ill health today and the major drivers of health care expenditure are those broadly categorised as non-communicable diseases such as cardiovascular disease, diabetes, and so forth. We are very pleased that, for the first time, this public health legislation will address these major causes of population ill health and disease in New Zealand today, although it is interesting to note, having said that, that only five slender pages out of an almost 300-page bill deal with this particular issue—that is, the issue of what we loosely call non-communicable diseases.

It is particularly appropriate that this bill is coming before the House now, because the Health Committee has spent a year or more inquiring into the obesity and type 2 diabetes epidemics. We have heard compelling evidence over the last few years that the key threats we face in New Zealand—as elsewhere, particularly in the Western World—are from the epidemics of obesity, type 2 diabetes, and so forth. We were informed by experts that if we do not deal with these epidemics, these diseases will overwhelm our health system. We had many experts warning that if we do not change the eating habits of young New Zealanders, in particular, then young New Zealanders will be the first generation of children to die before their parents. We will not have a lot of money left to deal with waiting lists and other things because we will be spending all of our money trying to cope with the consequences of obesity and type 2 diabetes. That is the evidence we have heard over the last couple of years in the select committee.

The reason for those epidemics is quite simply that we have created an environment in New Zealand where unhealthy foods are more heavily promoted, more available, and more accessible than healthy foods. There are overwhelming commercial pressures on our children to eat unhealthy food. The vast majority of submitters to the select committee called for changes to that environment. They said education alone simply would not work, any more than education alone worked in terms of reducing smoking in New Zealand. It is not going to work. Changing the whole environment is like turning around a supertanker.

The overwhelming majority of submitters said that we needed to change the environment and that education alone would not work. They said: “Please, put in some provisions or regulatory powers to enable the Government to restrict, for example, the advertising of unhealthy foods to children and to put in some marketing restrictions.” The overwhelming majority of submitters called for these provisions. So we are delighted that there is a very minor provision in the bill, which Tony Ryall referred to as that insidious paragraph (x) in clause 374. Thank goodness for paragraph (x), because that provision was what the vast majority of submitters and the majority of members of the select committee called for. Thank heaven that in 2007 in this Public Health Bill, which is supposed to be primarily dealing with non-communicable diseases—the major cause of population ill health today—we have one little paragraph, paragraph (x), which will allow us to look at this particular issue.

It is interesting that the National Party members departed from the rest of the select committee, who said: “Yes, this is an overwhelming problem that is going to bankrupt the nation and overwhelm our health system, and all our taxes are going to go up because we are going to have to cope with the consequences of obesity and type 2 diabetes if we do nothing, and if we do not change the environment.” But the National Party said: “Yes, we agree with all that, but education is all we need. All we need is a little bit more education and everything will be fine.” That is nonsense. It is the do-nothing approach. It is basically saying “Let’s do nothing. Let’s allow the food industry to have absolutely unfettered powers to target our young children with unhealthy food. Let’s have no restrictions on the ability of the food industry to make profits from wherever they can.” Instead of being honest and saying “Our approach is that we do not want any restrictions on the food industry.”, the National Party reframed the debate—as public relations people would say—and instead they said: “Oh, we don’t want nanny State. We don’t want any restrictions on the advertising of unhealthy food to children, because that would be nanny State.”

Perhaps the next speaker from the National Party could explain to me whether the regulations that we have to wear seatbelts in cars are nanny State? I do not see National Party members standing up and saying they are an outrageous imposition and nanny State. We have restrictions that say we cannot sell cigarettes and alcohol to children in schools. Is that nanny State? Should that be allowed? Surely by the National Party’s logic we should get in there and sell alcohol and cigarettes, because otherwise it is nanny State. It is a very clever reframing of the debate, but I think people need to know that all this is about, and what the debate will be in the select committee is whether we should allow the food industry the unfettered ability to target our children with unhealthy food, and continue the problems we have such as the obesity epidemic and type 2 diabetes. National members will say: “Oh no, it doesn’t matter if all our children are going to end up with type 2 diabetes, as long as we do not restrict the ability of the food industry to promote unhealthy food to children.” [Interruption] We are delighted with paragraph (x), which I can see is going to be the major issue of contention in the select committee.

However we do have some concerns with this bill. We are concerned with the powers in this bill that will enable schools to be closed to, or school attendance restricted for—basically—unvaccinated children. We think that there are significant issues here about the freedoms of people, and particularly, in this case, of unvaccinated children. We think there is a debate to be had, and we think that the vaccination groups in New Zealand will be very interested in some of the provisions in this bill. We will expect the National Party to support us strongly over these concerns. National wants maximum freedom and the minimum of intervention in our lives, so I am sure it will support us over those particular concerns. Having said that, we are very pleased with this legislation and like, I think, every other party in this House—although I am not sure of ACT, but certainly, the overwhelming majority of this House—will be supporting this bill. We look forward to its debate in the Health Committee and we look forward, in particular, to debating clause 374(x).

HONE HARAWIRA (Māori Party—Te Tai Tokerau) : Tēnā koe, Mr Speaker. I say tēnā koe to Mr Henare. I would like to congratulate the previous speaker on the most intelligent dissertation on this topic today.

Three months ago the Business Council for Sustainable Development did a survey that showed nearly 80 percent of New Zealanders believe that the public health service has worsened over the past 5 years. That same poll predicted that on the current rate of spending on health, at $11.6 billion a year, by the year 2050 the Government could expect to be allocating more than $21 billion a year to help. In the context of that high public interest and exorbitant expenditure, two other reports were issued that brought the matter to a head. The first was a comprehensive analysis monitoring the health of New Zealand children and young people, which concluded that children with chronic conditions, long-term disabilities, mental health issues, or conditions traditionally managed in the primary care and out-patients setting, such as diabetes, epilepsy, and chronic renal failure, were not being adequately captured by routine hospital or mortality data. That report also said that traditional data failed to capture issues of cultural identity or the role this played in health and well-being. Following on from these conclusions, Te Roopu Rangahau Hauora a Eru Pōmare tabled another report from their series, Hauora: Māori Standards of Health IV—A study of the years 2000-2005. As Dr Papaarangi Reid and Bridget Robson explained very clearly in the very first sentence of their report: “Māori have the right to monitor the Crown and to evaluate Crown action and inaction.” This is a right that derives from the indigenous rights of tangata whenua enshrined in Te Tiriti o Waitangi and embodied in the United Nations Declaration on the Rights of Indigenous Peoples.

So the stage is firmly set, from all perspectives, for this bill to start the process of legislative review for the effective management of public health. The explanatory note states that the bill is designed “to improve, promote, and protect public health” in order to help attain “optimal and equitable health outcomes for Māori and all other population groups.” A worthy purpose indeed—on that statement alone the Māori Party could support this first reading of the Public Health Bill.

So let us just see whether this bill achieves that goal. But, firstly, I want to put the statement made by Dr Reid and Bridget Robson into context. As tangata whenua our primary right to self-determination is understood in our capacity to be recognised as indigenous peoples. But it also extends to a sense of duty, of manaakitanga, to ensure the well-being of all people living in our territories. This means, logically, that Māori must monitor health, including any persistent disparities between Māori and non-Māori. Secondly, the urgency for Māori to monitor Crown performance is required by the consistent disparities in health outcomes, the ongoing exposure to determinants of ill-health, the overwhelming lack of responsiveness of the health service, and the ongoing under-representation of Māori in the health workforce. So the Māori Party shares with Māori health professionals the priority that must be given to a focus on Māori as a population group, and our collective responsibility for te ōranga o tō tātou whānau.

We must care about these longstanding inequities. We must not accept normalising and tolerating such unfair and unjust deficiencies of a health system meant to operate in everyone’s interests. We must care about Māori approaches and models being supported across purchasing environments. We know that the Māori health sector has had problems with the population-based funding models promulgated by district health boards and primary health organisations, because these models have insufficient resources to truly support stand-alone Māori or Pasifika primary health organisations. We know, too, that other determinants impact on whānau ora. Poverty, income, low-paid employment, all forms of violence, educational underachievement, dealings with the criminal justice system, income support, impoverished housing conditions, and isolation and alienation from other whānau members all impact on whānau well-being.

We have a major challenge in front of us. In particular, all research pathways lead to three major challenges that contribute to ethnic inequalities in health: differential access to specialist, general practitioner, and specialist-nursing services, and inadequate screening leading to slower pathways through health care; differences in the quality of care received; and differential access to determinants of health, such as the exposure to other risks like unsafe workplaces, substandard and crowded housing, and environmentally unsafe living conditions. But on top of that we have specific instances in Aotearoa linking institutional racism and interpersonal racial discrimination as a key factor accounting for much of the inequality between Māori and others. Evidence is relentlessly paraded through this House that shows that Māori receive lower levels of health services and poorer quality of service. Other evidence, including Ministry of Health analysis of the New Zealand Health Survey, confirms that discrimination may be an important cause for ethnic inequalities in health.

Yet, as unbelievable as it sounds, the Ministry of Health has still not filled the vacancy that has existed for much of this year in the appointment of the Deputy Director-General Maori Health. Given the quality of the applicants, the Māori Party finds it astounding that no appointment has yet been made. Alongside that, the public health unit itself has been diluted and its focus dissipated across the ministry. It now stands under the rule of the strategy directorate, rather than maintaining specialist public health leadership in one area. The statutory requirement to carry out public health advisory functions, as set out in section 3E of the Health Act of 1956, is thus compromised by organisational impediments. It remains to be seen how this bill will achieve equitable health outcomes for Māori or, indeed, manage the risks of emergent threats to public health without having the organisational structures in place to address these inequalities.

The desired change is not impossible. We have not reached the point of no return. All it would take to make a big difference would be to focus on the issues of significance to Māori, to focus on Māori development, and to guarantee a specific focus to address and eliminate inequitable health outcomes for Māori. A big part of making a difference would be to instigate the mandatory collection of ethnicity data and mandatory analysis by ethnicity at all points throughout the public health sector, including planning and management. We note, of course, the correlation with the Monitoring the Health of New Zealand Children and Young People report, which was also concerned about the paucity of data. I said before that we have not reached the point of no return, but we do not also want to be so hands-off that we drift off down a one-way street that ends up in a policy cul-de-sac, closing off all possibilities for progress.

It gives us huge concern that despite the upfront, stated objective of equitable health outcomes for Māori, there is nothing that specifically gives weight to that commitment. There has been no consultation with Māori. There is no commitment in the Public Health Bill to Te Tiriti o Waitangi. There is no explicit focus on inequities or Māori health development. It appears to be another case of “Do what I say, not what I do.” In fact, other than the purpose statement at the front of the bill, Māori seem to be completely absent from the entire bill. We are prepared to let this bill go to the select committee, as we are keen to enable Māori health collectives and professionals to have their say at the table. But we signal our strong concern, which is the unnecessary, avoidable, unfair, and unjust ethnic inequalities that continue to plague the sector. Public heath must benefit from specific focus on Māori if we ever hope to make the difference that is really needed. Kia ora, Mr Deputy Speaker. Tēnā tātou katoa.

JUDY TURNER (Deputy Leader—United Future) : I stand on behalf of United Future to support, along with other parties, the first reading of the Public Health Bill. I am particularly pleased to see that the House is giving this bill the opportunity to be considered by the Health Committee. It is interesting to consider that it is over 50 years since legislation was looked at, in this regard. This bill also replaces the Tuberculosis Act from around that time, and in discussing such legislation we are looking at a time in New Zealand’s history when the majority of New Zealanders died from communicable diseases.

Here we are, all this time later, and the health environment within New Zealand has changed quite dramatically. Now New Zealand health professionals, and in particular the New Zealand health dollar—which will always be rationed no matter how ideal we get the system to be—are dealing with a death rate that is largely fuelled by non-communicable diseases. So there is an intention and an attempt within this bill to bring some public health initiatives into law around non-communicable diseases.

The bill is divided into eight parts, and I want quickly to flick through them. The first concerns the powers, functions, and duties of various key players in the health sector, such as those of the Minister of Health, the Director-General of Health, the Director of Public Health, district heath boards, territorial authorities, and the like. It is very clear that under this bill the powers that those functionaries have are clearly specified and laid out.

The second part of the bill deals with health information, notification, and reporting, and it also includes the cervical screening provisions that were put in place in the previous Parliament. It talks about updating existing audit provisions, and it provides for the notification of specified conditions, which is fairly straightforward.

The third section, which is one I mentioned at the beginning of my speech, concerns the issue of non-communicable diseases. It provides principles and non-binding codes for reducing the rates of non-communicable diseases. This is the controversial part of the bill. I remember that some time ago when I was on the Health Committee, we had a briefing from health officials. I cannot remember what we were having a briefing on, but we asked them about the different ways the Government could respond to a particular circumstance. They said there were three ways. The Government could do nothing, and sometimes that is the best way to respond to a health situation—for example, if it is a virus that is going around, it will be gone soon, so we do nothing and let it take its course. The next thing was to involve public health education, and the third thing was to regulate.

This bill brings in a fourth provision, which would kind of slot into the middle of that continuum. It is the introduction of non-binding codes. This is not full-on regulation; it is a step beyond education, and it certainly allows the Ministry of Health to make some sensible suggestions. One of the areas that came to mind, which I think is an area where we need some non-binding codes right now in New Zealand, is the issue of foetal alcohol syndrome. When I was a young mum—

Hon Tau Henare: A long time ago now.

JUDY TURNER: —it was a long time ago; I admit that—we were advised by our general practitioners that a moderate amount of alcohol consumption was actually OK and would not do any harm. Most of the young mums I got to know consumed mild amounts of alcohol during their pregnancies in the mistaken belief that it was perfectly safe. New scientific evidence now suggests that the advice we should be giving to young mums is that they should go nowhere near alcohol during the term of their pregnancies. There are genuine cases where it has been very clear that even moderate or mild consumption of alcohol during sensitive parts of a baby’s development has created this syndrome. We have a high incidence of that in New Zealand, and we should consider that there is an area where some really interesting non-binding codes could be introduced to make a real difference to the health outcomes of literally thousands of New Zealand children. That is what this bill seeks to introduce.

I note the speech made by the Hon Tony Ryall. He talked about clause 374, and he is quite right in his warning about that. I do not want to sound as if I am criticising him, because he is quite right. When we look at clause 374, which is about the regulations around public health in a general sense, we see that all the way through, in paragraphs (a), (b), (c), (d), and so on, it is mainly talking about communicable diseases. Then we get to a little paragraph, paragraph (x), which slips in the ability for there to be some guidelines to “reducing, or assisting in reducing, risk factors … associated with, or related to, non-communicable diseases:”. That paragraph could be completely overlooked. It has been slipped in there, and I would like to think that during the select committee process some clarity will be given to it. Is it about non-binding codes, or is it about something that could possibly be considered to be a bit more onerous? United Future accepts that there are some concerns. I have certainly been reading some publicity around concerns on that matter, and I think we need to be very clear as to what is being proposed there.

Beyond that third part of the bill are some provisions for the management of conditions posing health risks—that is, to do with communicable diseases—which basically roll over some of the existing provisions in the Act and identify some new and more modern risks of communicable diseases. The bill talks about the role of territorial authorities, particularly in relation to environmental health and the provision of sanitary works. It also deals with the interesting issue of stopping “nuisances”, which will be an interesting thing for the select committee to look at. It talks about regulated activities, and when we look at the regulated activities we see the breadth of what this bill has to cover. Those are activities—such as hairdressing, and needle and syringe exchange programmes—that currently come under some form of regulation, and the bill talks about the fact that there is currently a serious gap in the heath provisions for some of those regulated activities, a gap we need to look at under this bill.

I move to the provisions concerning emergencies and border health. That is where the “all risks” approach to emergencies comes in. The “all risks” approach is specifically to do with emergencies and border controls around health issues, such as severe acute respiratory syndrome, bird flu, and those types of issues. Part 8 of the bill covers miscellaneous provisions.

This is a fascinating bill, and United Future is disappointed that we do not enjoy representation on the Heath Committee. We wish the committee members well in their consideration of and deliberation on this bill, and we are happy to support its first reading.

LESLEY SOPER (Labour) : I thank the very good Minister of Health for bringing this important Public Health Bill to the House tonight. Moving away from the conspiracy theories of the National Party speakers, I would like to emphasise in my speech the important role that the bill has in extending to New Zealand’s borders protection from public health risks.

The Public Health Bill will replace the Health Act 1956. The Health Act contains many provisions that aim to protect New Zealand’s borders by preventing, reducing, or eliminating the spread of risks to public health at the border. However, the Health Act provisions were written 50 years ago, and they reflect the fact that back then ships were the predominant form of international travel. Whereas it was a great novelty in 1956 for my father to travel internationally entirely by plane, aircraft now carry most people travelling between countries. The Health Act provisions are also very specific on the diseases that the border health provisions can be used to manage. The Act provides that anyone who disembarks from a boat or ship is liable to quarantine. However, that provision can be invoked only if the person is known to have one of four listed diseases: yellow fever, plague, cholera, or avian influenza. That is obviously inadequate in this day and age. The bill expands the provisions in the Health Act so that all risks to public health, irrespective of cause, can be acted upon.

Let me paint a scenario as to when the new provisions in the Public Health Bill may be invoked. Imagine that a plane is arriving in New Zealand. During the flight to New Zealand four passengers start coughing blood and bleeding from their nose and bowel, and record very high temperatures. The captain of the flight notifies a medical officer of health in New Zealand that four of the passengers have taken ill, and describes their symptoms. The captain requests travel information from the passengers. Nobody at this stage knows what is wrong with any of the passengers. When the plane lands at Auckland airport the medical officer of health and other ground staff are on hand to meet the passengers. The medical officer of health uses powers under the Public Health Bill to quarantine all the passengers and crew on board the flight. This means that all the passengers are moved to a special facility where they are isolated from members of the public to prevent the spread of the condition. Although no one is yet aware of what is causing the passengers’ symptoms, the symptoms are very concerning, and it is considered that they may be a serious risk to public health. While in quarantine the cases can be further tested to determine the nature of the disease and the threat it poses, and, of course, the people can receive treatment. [Interruption] May I point out that certain vessels full of sound and fury on the other side of the House tonight signify nothing. Other passengers can also be monitored to determine whether they are also developing the condition.

The Public Health Bill empowers medical officers of health to take action to protect New Zealand’s borders from conditions that are suspected of being a serious risk to public health. Under present legislation, passengers on board a ship or plane can be quarantined only if they are known to have one of the four specified diseases I mentioned earlier. The Public Health Bill will allow all risks to be managed at the border, including viruses that we do not even know about yet.

The bill also contains new provisions to control people departing from, as well as those arriving in, New Zealand, to prevent the export of sources of public health risk. New Zealand is part of an international community and we owe it to our neighbours not to export diseases, conditions, or contaminants that may be a risk to public health. That is particularly important given our direct flights to the Pacific region. Medical practitioners or medical officers of health may advise the relevant airline, carrier, or country about a person with a quarantinable condition that is specified in the bill who is intending to leave the country and who is a health risk.

The bill will assist New Zealand’s compliance with the 2005 International Health Regulations that came into force in June 2007. These require New Zealand to be able to implement a full range of health measures at the border to ensure that threats to public health can be managed. New Zealand, of course, is bound by those regulations. The most important benefit of the International Health Regulations is the greater level of global health security that will come from having a coordinated global surveillance and response system for managing emerging health hazards.

Protecting New Zealand’s borders from all risks to public health is an important function in this day and age when risks and threats can come from many directions and causes. The Public Health Bill will keep New Zealand’s border control legislation in line with the 21st century. I commend the Public Health Bill to the House, and, like other sensible members of the Health Committee, I am looking forward to the submissions.

Dr JONATHAN COLEMAN (National—Northcote) : That was all very earnest and dreary, but, frankly, there was nothing in that speech to show why we should be rushing through the first reading of the Public Health Bill under urgency tonight. We have had the Public Health Act for 50 years—since 1956—yet this Government feels a need to push this bill through under urgency right at the end of the year. That had me wondering why that is. It is pretty clear why—in this 259-page bill, one has to get right through to page 213 before one gets to the Trojan Horse clause.

I would say that the Government was hoping that at the end of the year, in the festive season, it could just rush the bill through under the nose of the public and the Opposition, and that all of us, like them, would not have read the bill. Well, that is actually not correct. We have read the bill and we have found what the Minister has been trying to hide in it. The Minister has been trying to hide the power to exert some very Draconian influence that can be used if the Minister does not get his or her way. What will happen is that if the voluntary codes do not work, the Minister will regulate. There will be more of this nanny State stuff that, frankly, the public of New Zealand are absolutely fed up with.

It is quite interesting that in the commentary to this bill there is nothing about this Trojan Horse clause. It is quite interesting that in the Minister’s press release she made no reference to it. It is quite interesting that the Government thinks that if it puts up Lesley Soper for long enough, with her boring, drab monotone, people will go to sleep listening to stuff about border controls and will not see the real nanny State stuff in here, which, frankly, the people of New Zealand are absolutely sick of. [Interruption] Martin Gallagher knows how badly it went down in his electorate when the Government decided it was going to try to regulate tuck shops. It went down very poorly. It just shows that we have a Government that thinks that whatever it does inside the beltway with the white, liberal establishment in Wellington just does not matter. The Government members do not give a toss about the New Zealand public. They think they can ram through anything they want.

Having said that, I note that there are some good elements of this bill. We agree that the legislation needs an update and we will be supporting this bill’s referral to the select committee, but we will have some really hard debates with these failed Labour Party lackeys when we get there. We will be going through this bill clause by clause. I tell members that the National Party will not stand for this State-dominated regulation that these guys are going to foist on the public of New Zealand. This will be an election issue. It really will be.

The Government thinks it can legislate against diabetes and obesity. It thinks that New Zealanders want to be told what they can eat at the tuck shops of the nation. We heard Sue Kedgley speaking before. She was talking about the National Party and about what happened on the obesity inquiry. I can tell members what the Green Party’s priorities for health are. Would members believe it? We spent more time on an inquiry into aspartame in chewing gum than we did on child cancer services in Wellington. That was because the Greens and Labour dominate the Health Committee. [Interruption] That is right. That is where their health priorities are. They are not saying anything now because they know that is right. The fact is that for once I agreed with Hone Harawira. This Government has completely let Māori down in the area of health. It has done nothing, really, for Māori health. [Interruption] It has not. It has been pathetic and poor.

This bill will be pretty controversial, and we will have a real battle in the select committee. Government members think they can hide the Trojan Horse clause on page 213 of a 259-page bill and rush it through under urgency, but that just will not wash. It is just another example of this Government thinking it can fool the public of New Zealand and get stuff through that the public are strongly, strongly opposed to. They will pay for it at the polls next year, I can tell members that.

We concede that a few things have to be updated in relation to communicable diseases. We have had SARS. We are in the age of bird flu. Indeed, I will grudgingly concede—even though the list member from Southland, who is soon to be retired, made such a terrible speech—that we do have to have border controls to take steps against communicable diseases entering New Zealand. But on the issue of non-communicable diseases, if we cannot change the way people think about stuff like obesity and diabetes, and if we cannot convince them that they want to make healthy choices as of right, we will not be able to tackle obesity. We cannot legislate for this stuff. People want to have the choice to eat what they like. If we give them the right education, if we give them choices, and if they learn from an early age, they can be educated into making those right choices.

I say in summary that, yes, we will support the Public Health Bill being referred to a select committee, but we will see what happens there. We will certainly not be supporting any of the Draconian legislation that the Labour Party has hidden away on page 213 of a 259-page bill.

MARTIN GALLAGHER (Labour—Hamilton West) : We have listened to an exercise in absolute cynicism from members opposite. We have heard the dog-whistle speeches from over there. For the benefit of people who are watching this debate tonight, I tell them that National is actually supporting the Public Health Bill. National members go into some sort of diatribe, and because Government members are concerned with the outbreak of diabetes, or concerned with the issues that Sue Kedgley and my good colleague Lesley Soper raised about critical public health issues, we are somehow accused of being politically correct and of running a nanny State. Well, talk about what we call dog-whistle politics! The classic was the member for Northcote, who admitted: “Well, I am saying all of this stuff for public consumption, but—cough, cough—by the way, we support the bill.”

Lesley Soper: They are hollow, that’s all.

MARTIN GALLAGHER: They are hollow, all right. They are hollow vessels—hollow men and hollow women. I stress that this bill will become the primary public health statute for New Zealand and that it replaces outdated legislation for public health—the Health Act 1956 and the Tuberculosis Act 1948.

In my brief call I take the opportunity to commend all the people who are working in the field of public health—the public health officers working for the Ministry of Health up and down the country—for the excellent job they do. Instead of slagging off those people and implying that people who work for local government are somehow politically correct, grey inspectors poking about, I commend them for the excellent job they do in public health in this country.

If members want an example of leadership, I tell them that this is a Government that is showing, yet again, excellent leadership with this very, very important legislation. Indeed, this bill is a very good way forward. I strongly support the bill and am deeply disappointed in the Opposition members, who, in spite of all the rhetoric, cough and splutter and say they support the bill. Thank you, Mr Assistant Speaker.

• Bill read a first time.

• Bill referred to the Health Committee.